Morphological Changes of Liver Among Post-Fontan Surgery Patients

Liver screening and longitudinal study of Fontan Associated Liver Diseases (FALD) is essential to identifying hepatomegaly and how hepatomegaly relates to various stages of liver fibrosis. In this study, we investigated longitudinal liver shape changes and liver stiffness in a cohort of patients with Fontan Associated Liver Disease.

We used 170 image volumes of 40 Fontan stage 3 completion patients. We also used 65 computed tomography images of healthy individuals from three datasets for comparison. Thirteen radiomic shape features of Fontan patients and individuals with a healthy liver were extracted and analyzed longitudinally. We studied correlations among features, liver spleen ratio, and liver stiffness with shape features.

The enlargement of the liver, along with all shape features, was observed in all post-surgery intervals related to hepatomegaly and fibrosis. The shape features of healthy individuals and Fontan cases differ significantly in the longitudinal analysis and in the liver-spleen ratio. There is a positive correlation among body mass index, body surface area, age, Fontan surgery years, and liver stiffness.

The changes in shape features between Fontan patients and healthy subjects are statistically significant, which shows the relation for hepatomegaly and liver fibrosis. Accurate delineation of these features with artificial intelligence-based segmentation could serve as a valuable adjunct for the clinical follow-up of Fontan patients.